Do you know the different types of asthma? Advances in our understanding of asthma have helped experts define specific types of asthma, such as exercise-induced asthma (asthma that happens when you exert yourself) and nighttime asthma (asthma that makes sleeping miserable and is quite serious). Understanding the type of asthma you have can help you seek the most effective treatment when you have an asthma attack.
Allergies and Asthma
Allergies and asthma often go hand-in-hand. Allergic rhinitis (also called hay fever) is inflammation of the lining of the nose and is the single most common chronic allergic disease. In those with allergic rhinitis, increased sensitivity (allergy) to a substance causes your body’s immune cells to release histamines in response to contact with the allergens. Histamines, along with other chemicals, lead to allergy symptoms. The most common allergens enter the body through the airway.
With allergic rhinitis, you may feel a constant runny nose, ongoing sneezing, swollen nasal passages, excess mucus, weepy eyes, and a scratchy throat. A cough may result from the constant postnasal drip. Many times, asthma symptoms are triggered by allergic rhinitis. Your doctor may prescribe medications to control the allergies and, in doing so, the cough and other asthma symptoms may subside.
Exercise-Induced Asthma
Exercise-induced asthma is triggered by exercise or physical exertion. Many people with asthma have some symptoms with exercise. But there are many people without asthma, including Olympic athletes, who get symptoms only during exercise.
With exercise-induced asthma, airway narrowing peaks 5 to 20 minutes after exercise begins, making it difficult to catch your breath. The symptoms begin within a few minutes of starting exercise and peak or worsen a few minutes after stopping exercise. You may have symptoms of an asthma attack, with wheezing and coughing. Your doctor can tell you if you need to use an asthma inhaler (bronchodilator) before exercise to prevent these uncomfortable asthma symptoms.
Cough-Variant Asthma
In cough-variant asthma, severe coughing is the main symptom. There can be other causes of coughing, such as postnasal drip, chronic rhinitis, sinusitis, or gastroesophageal reflux disease (GERD or heartburn). Coughing because of sinusitis with asthma is common.
Cough-variant asthma is vastly underdiagnosed and undertreated. Asthma triggers for cough-variant asthma are usually respiratory infections and exercise.
For any persistent cough, contact your doctor. They may order specific asthma tests, such as lung function tests, to show how well your lungs work. You might need to see a lung specialist for further tests before an asthma diagnosis is made.
Occupational Asthma
Occupational asthma results from workplace triggers. The list of known triggers is long and varied, but they are usually things that you breathe in (or inhale). With this type of asthma, you might have trouble breathing and asthma symptoms just on the days you're on the job.
Many people with this type of asthma have a runny nose and congestion, eye irritation, or a cough instead of the typical asthma wheezing.
Occupational asthma can happen in almost any line of work or any work environment, including offices, stores, hospitals, and medical facilities.
Some common jobs that are tied to occupational asthma include animal breeders, farmers, hairdressers, nurses, painters, and woodworkers.
Occupational asthma triggers include:
- Contaminants in the air such as smoke, chemicals, vapors (gases), fumes, or dust
- Respiratory infections, such as colds and flu (viruses)
- Allergens in the air, such as molds, animal dander, and pollen
Two types of occupational asthma attacks happen:
- Aggravation of preexisting asthma. This is by far the most common type. Over time, with regular contact, you become very sensitive to the trigger. With this asthma, continued exposure to the trigger causes attacks.
- Irritant asthma. Contact with certain things or conditions in the workplace irritates the airways, causing symptoms right away. Although this is not an allergic-type reaction, the irritation may cause allergy-like or asthma-like symptoms.
Once the attack is triggered, the airways begin to swell and tighten (bronchospasm) and make mucus. The swelling and extra mucus partially block, or obstruct, the airways. This makes it harder to push air out of your lungs (exhale).
Recognizing and avoiding the asthma trigger is especially important in occupational asthma.
Because people spend so much time at work, those with occupational asthma tend to have a lot of exposure to their trigger by the time the cause of the symptoms is recognized as asthma. The more time you spend with your trigger, the more likely you are to have permanent lung inflammation and very sensitive airways.
Occupational asthma is the most common work-related lung disease in developed countries. In up to 15% of people with disabling asthma in the United States, the condition is at least partly related to their work.
Nighttime (Nocturnal) Asthma
Nighttime asthma, also called nocturnal asthma, is a common type of the disease. If you have asthma, the chances of having symptoms are much higher during sleep because asthma is powerfully influenced by the sleep-wake cycle (circadian rhythms). Your asthma symptoms of wheezing, coughing, and trouble breathing are common and dangerous, particularly at night.
Studies show that the most deaths related to asthma happen at night. It’s thought that this may be because of more exposure to allergens (asthma triggers), cooling of the airways, reclining position, or even hormone secretions that follow a circadian pattern. Sometimes, heartburn can trigger asthma symptoms at night. Sinusitis and asthma are often problems at night, particularly when postnasal drip triggers symptoms such as coughing.
If you have asthma and notice your symptoms getting worse as the evening goes on, it’s time to see your asthma doctor and figure out the causes of asthma. Knowing the right asthma medications and when to take them are key to managing nighttime asthma and getting quality sleep.
Thunderstorm Asthma
Thunderstorm asthma can happen when heavy storms hit on a day with a very high pollen count, usually during the spring, and cause symptoms of an asthma attack.
Grains of pollen get sucked into the storm clouds. Once those grains take in a certain amount of water, they pop, making even smaller grains. Those smaller grains get into the wind at ground level. There, they can be breathed in easily. That can lead to asthma attacks.
It most often hits adults who have asthma or hay fever or are allergic to grass pollen. But it can cause problems for anyone, even if you don’t have those things. Cases of thunderstorm asthma that affect large numbers of people are rare. They’ve been reported across Europe, Australia, North America, and the Middle East.
No major outbreaks have happened in the U.S., but researchers in Atlanta found that a few more people in their area go to the emergency room with asthma-related symptoms during thunderstorms: about 3% more than usual.
You can’t control pollen counts or thunderstorms, but you can control how you’re affected if they come together. If you have asthma or hay fever or are allergic to grass, the best thing to do is keep your condition under control and know how to handle an asthma attack if you have one.
If you have hay fever or allergies, see a specialist to figure out your triggers. If you’re allergic to pollen and your doctor wants you to have treatment for it, be sure to start taking your meds at least 6 weeks before high-pollen season begins.
Keep an eye on the weather, too. On high-pollen days, especially if thunderstorms are expected, try to stay indoors and keep your windows closed. It’s especially important to stay out of the high winds that come just before thunderstorms.
Health Conditions That May Mimic Asthma
A variety of illnesses can cause some of the same symptoms as asthma. For example, cardiac asthma is a form of heart failure in which the symptoms mimic some of the symptoms of regular asthma.
Vocal cord dysfunction is another asthma mimic. Many recent reports have drawn attention to a peculiar syndrome in which abnormal vocal cords cause wheezing that is frequently misdiagnosed as asthma. This is most common in girls and young women who have loud and dramatic episodes of wheezing that do not respond to medications that open the airways.
